Revised 11/30/09
Los Medanos College
Age Waiver Form
Student Name (print):_____________________________________________ LMC Student ID:________________
Los Medanos College admits high school students 16 years of age and older. Students who are 14 or 15 years of age at the
beginning of the term may apply for a waiver of this policy. Please complete this form and attach it to your completed Special
Admit Enrollment form. You must also take the LMC High School Student Online Orientation and attach the completion
certificate to this request. In order to be considered, you must fill out this form completely, including an explanation of why you
are making the request.
Note to Students and Parents:
1. LMC is a rigorous academic learning environment designed for adult learners. Content in some classes may not be suitable
for minors. LMC will not alter class curriculum or teaching methods to accommodate non-college age students.
2. Parents are responsible for reviewing course information to ensure that the content, academic level and prerequisite skills
are appropriate for their son(s) or daughter(s).
3. Parents should ensure that their minor son(s) or daughter(s) has access to a parent (i.e., cell phone) in case of emergency,
class cancellation, campus evacuation, or any unexpected event.
4. Parents should ensure that their child’s maturity level is appropriate for an adult learning environment.
Current Grade in High School: _____________ Date of Birth: ______________________ Age: ______________
Check term/year:
Summer Fall Spring Year: _______________
Class/Classes I wish to take (list Classes)
Please explain in the space below your reasons for your request.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
My Parent/Guardian (signature below) is also taking the class(es) with me Yes No
Parent/Guardian Printed Name: _________________________________________Student ID of Parent: __________________
Student Signature: ____________________________________________________________ Date:______________________
Parent/Guardian Signature: _____________________________________________________ Date:______________________
Official Use Only:
Approved Denied
Signature of Dean/Manager _______________________________________________ Date: ___________________________
Comments: ____________________________________________________________________________________________
______________________________________________________________________________________________________
